The participative arts for people living with adementia: a critical review

By HANNAH ZEILIG1, JOHN KILLICK

2 & CHRIS FOX3

Abstract

In the last decade, interest has increased in the role of the participativearts for people who are living with a dementia. The flourishing of this areacan be partly understood because of an awareness of the potential for artto deliver health care outcomes. In addition, there is widespread agreementthat non-pharmacological interventions are important for people livingwith a dementia. Therefore, participative arts activities have attractedattention as representing beneficial interventions. This critical review whichinvolved the careful mining of academic and grey literature using replicablesearch strategies contextualises the participatory arts for people livingwith a dementia and provides an overview of some of the art forms thatare most widely used. The review also highlights some of the extant gapsin the knowledge base. The focus is on the UK context but the role of theparticipative arts for those with a dementia is equally relevant to practi-tioners in Europe and the US, and therefore some attention was also givento international literature.

Keywords: participatory arts, dementia, intervention, health, well-being,quality of life.

1 Hannah Zeilig, London College of Fashion, University of the Arts, London, UK2 John Killick, Dementia Positive, Hebden Bridge, UK3 Chris Fox, Norwich Medical School, University of East Anglia, Norwich, UK

International Journal of Ageing and Later Life, 2014 9(1): 7�34. # The Authors

7

Introduction

Dementia is a broad term and relates to a group of syndromes ratherthan one single disease entity. To date, more than 200 subtypes of dementiahave been defined and each one has a different pathway or process (Stephan& Brayne 2010). However, in general terms the dementia syndrome ischaracterised by progressive decline in cognition of sufficient severity tointerfere with activities of daily living (Knopman et al. 2001). The mainsubtypes include Alzheimer’s disease (AD), vascular dementia, dementiawith Lewy Bodies, frontal lobe dementia, Pick’s disease, and alcohol relateddementia (Stephan & Brayne 2010).

‘‘Dementia’’ is therefore a syndrome that defies any simple definition;it has become a fear-laden term that encapsulates society’s worst terrors(Zeilig 2014a). Despite the general lack of consensus about what dementiais in neurological terms, there is agreement that dementia is a long-termmedical disability. To this end, there are regular reports in the mediaand elsewhere concerning the prevalence of the condition both in Europeand globally. The recent G8 summit (December 2013, London) highlightedthe importance of countries working together to find a cure: http://dementiachallenge.dh.gov.uk/category/g8-dementia-summit/

However, at the present time, finding a cure or even effective drugtreatments is proving elusive. Thus a growing body of research and workhas steadily focussed on improving quality of life (QOL)1 for people livingwith a dementia (PWD) (Gross et al. 2013). The importance of reducingthe use of antipsychotics for PWD and therefore investigating ‘‘non-pharmacologic tools’’ has also been widely embraced across the US (Kaldy2013). In the absence of appropriate pharmacological interventions thesocial conditions in which those with a dementia live also need urgentattention. Pioneering work by researchers and practitioners has contributedto the understanding that although Alzheimer’s and other dementiasmay be incurable at present, they are conditions that can be treated and

1 There are debates and disagreements in the research literature concerning 1) howto measure QOL and 2) what QOL actually refers to. The lack of consensus aboutthis contributes to a lack of reliable assessments of projects. It is not within thescope of this review to address these controversies.

International Journal of Ageing and Later Life

8

that treatment always includes more than drugs (Killick 2013; Kitwood1997; Sabat 2001; Zeisel 2009).

Interest in the social conditions that affect dementia is part of the socio-political context that has led to a burgeoning of arts and cultural initiativesfor PWD. These initiatives are diverse and reflect an increasingly prevalentassumption that the arts and culture play an intrinsically positive role inhealth andwell-being. However, there has been very little critical evaluationor review of these initiatives and interventions. Indeed, there are gaps in theevidence base relating to the real and measurable benefits from culturalactivities for people with a dementia. This is largely because the field is stillin its infancy.

The overall aim of the following review is to strengthen the knowledgebase concerning the efficacy of arts based approaches for PWD and toinvestigate the question: What is the value of arts and culture for people livingwith a dementia? The broad question being explored here is in contrastto previous reviews, which have tended to focus on the specific impactof particular arts interventions on PWD for purposes of evaluation or inorder to measure particular variables such as episodic memory or aestheticstability.

The review is a comprehensive analytical and rigorous discussion.However, it is not systematic as it is not an exhaustive summary, did notuse meta-analysis, and although selection bias was minimised by ensuringthat colleagues used the same search terms and databases, it was solely thePrincipal investigator (PI) that was responsible for synthesising the data.

Key databases were searched using the following terms:

(dementia* OR alzheimers OR vascular OR multi-infarct*)AND(cultural OR portraiture OR film* OR television OR tv OR memoir* OR novel*OR poe* OR theatre OR performance OR art* OR storytelling OR stories OR musicOR sing* OR danc* OR galler* OR archive* OR museum OR ‘‘creative writing’’ ORfashion OR drawing OR paint* OR craft* OR choral OR choir OR panto* ORcollage OR design)ANDUK OR ‘‘united kingdom’’ OR engl* OR welsh OR wales OR Scot* OR Irish orIreland

The participative arts for people living with a dementia

9

The databases that were used include:

ScopusWeb of KnowledgeSocial Policy and PracticeApplied Social Sciences Index and AbstractsBritish Humanities IndexBritish Nursing IndexInternational Bibliography of the Social SciencesSocial Services AbstractsSociological AbstractsGlobal HealthHealth Management Information ConsortiumPsycINOMedlineCochrane

An endnote library was created of 222 references. Of these the articlesthat were targeted were those including:

. Explicit reference to creative activities that involved older PWD,

. The role of museums and/or art galleries for PWD,

. Participatory arts activities that aim to enhance well-being or QOL forPWD,

. Participatory arts activities that focussed on aesthetic appreciation forPWD,

. Activities that did not include therapies of any kind,2

. Systematic data/meta-analyses about the value of the arts for olderpeople, including one Cochrane Review on music therapy for PWD.

A total of 63 articles form the basis for the ensuing examination of therole of the arts for PWD, however the preceding contextual backgroundon the relationship of the arts to health, includes additional references andis provided as an essential framework for the review.

2 The focus was on the participatory arts and not therapies (art, music, or drama);however, several articles exploring music as a therapeutic intervention werereviewed where these included relevant methodological information.

International Journal of Ageing and Later Life

10

The evidence pertaining to the role of particular arts activities is thendiscussed in some detail.

Context: The Arts and Health

In order to correctly define art, it is necessary, first of all, to cease to consider it as ameans to pleasure, and to consider it as one of the conditions of human life. (from:‘‘What Is Art?’’ by Leo Tolstoy)

Debates concerning the relationship of the arts to society can be tracedback to Plato and Aristotle and continue to vex contemporary commenta-tors. Tolstoy’s conception of art as integral to human life is an argumentthat has some contemporary resonance. In the twenty-first century in theUnited Kingdom as beleaguered arts and cultural organisations are facingsignificant economic challenges (Clift et al. 2009; Mowlah et al. 2014) thereis an increasing urge to articulate the pivotal role that the arts and cultureplay in all aspects of our lives, including centrally to our health and well-being. The need to raise awareness concerning the role of the arts as a‘‘strategic national resource’’ is explicitly stated in a recent report by ArtsCouncil England (Mowlah et al. 2014) and similarly underlies the reportby Renshaw (2013). Thus the sociopolitical context in the UK for inves-tigating the value of the participative arts for PWD has also been con-ditioned by the need for arts organisations to respond to major politicalchanges and funding constraints. This has resulted in an awareness thatarts organisations need to actively engage with a more diverse populationand a growing appreciation that participatory work/practice that issocially engaged is inherently valuable (Parkinson et al. 2013; Renshaw2013).

Beyond the important contextual background is the growing body ofscientific evidence in support of the value of the arts for health (Clift et al.2009). Research has evidenced that a higher frequency of engagement witharts and culture is associated with a higher level of subjective well-being(Mowlah et al. 2014) and also that there are instrumental benefits from thearts that can positively affect physical health (Clift 2012). To this end, it hasbeen argued that by supplementing medicine and social care, participation

The participative arts for people living with a dementia

11

in the arts and access to a range of arts opportunities can dramaticallyimprove QOL (Burnham et al. 2007; Cayton 2007; Owen 1999; Staricoff2006). In connection with this, there has been a growing awareness thathealth may involve more than simply the absence of disease and that artand aesthetics have an important role to play in delivering health care(Moss & O’Neill 2014) as well as a reappraisal of the associations betweenthe arts and society in general.

Indeed, the role of the arts for addressing health issues and as a modefor the delivery of social care has been a recurrent topic this century bothin Europe and the US (Buttrick et al. 2013; Cohen et al. 2006, 2007; Hanna& Perlstein 2008; Ramsey 2013). This interest is fuelled by an expandingbody of research into the links between culture and flourishing (2013).In addition, there has been explicit interest in the possibility that the artsrepresent a relatively cost-effective way of alleviating health issues(Ramsey 2013). Work by Cohen (2009) convincingly reports on the costeffectiveness of art programmes in relation to medication usage and visitsto the doctor amongst a sample of older people in the US. Of course,successful participatory arts projects are of much greater value to theindividuals that take part than the economic benefits they may representfor health or other agencies.

However, it should also be noted that the arts in health movement hasnot been without its critics. As Clift et al. (2009) have highlighted,a collection of essays by the Mirza (2006) challenged the evidence basefor claims concerning the personal and social benefits of the arts. Morerecently the ‘‘fulsome’’ language and ‘‘somewhat uncritical stance’’ of‘‘evangelists of the arts and health movement’’ has been criticised:

Equally, reviews of the efficacy of arts in health care . . . rarely stand up to sustained

academic scrutiny, with a tendency to mould weak data and speculative associations

into an often less than convincing polemic. (Moss & O’Neill 2014: 1032)

It is hoped that as Moss and O’Neill propose, this article will help tocontribute to the development of a more reflective and critical line ofreasoning concerning the role and value of the arts in particular for PWD.

International Journal of Ageing and Later Life

12

The Participative Arts for PWD

Here, the participative arts refer to professional artists that conduct creativeor performing arts projects in community settings with PWD and theircarers. The purpose of these projects is predominantly to promote healthand well-being and is therefore therapeutic. However, it should be notedthat in some cases the use of the arts with PWDmight also be primarily foraesthetic purposes � in order to create a high quality work of art. Clearly,the therapeutic and aesthetic objectives of a project may overlap andcomplement one another.

This is distinct from the work of art therapists who typically work inclinical settings (hospitals or hospices) and are usually health care pro-fessionals who aim to ameliorate specific conditions (Castora-Binkley et al.2010). In addition, therapists (whether these are dance/movement, music,drama, or art therapists) tend to focus on the condition (whether this is adementia, a psychological, or physical problem for instance) and how thiscan be ‘‘treated.’’ For therapists, the arts (whether these are music, painting,theatre) are used as tools to achieve measurable ends. Although this is avaluable approach, the focus of this review is on the arts as a possible meansof engaging PWD rather thanways of treating the symptoms or aetiology ofthe illness itself.

The growth in understanding about residual creative ability that exists inPWD has added to interest in researching and initiating arts projects forPWD (Moriarty 2003; McFadden et al. 2008). Indeed, some practitionersargue that ‘‘the peculiar circumstances’’ of dementia might even release aninnate creativity that is connected with an inventive immediacy (Craig &Killick 2011). Whether or not creativity is augmented by dementia (and atthe present time there is scant research on this issue), it is widely appre-ciated that there is a need to findmeaningful and engaging interventions forpeople who live with a dementia, whether they are living in the communityor in care homes, and that the participative arts can improve PWD’s moods,enhance their relationships, reduce social isolation, and provide sensorystimulation (Guzman-Garcıa et al. 2013). Moreover, the participative artsmay provide unique access to the emotional and physical memories ofpeople who live with a dementia even while their cognitive capacities arediminishing (Eekelaar et al. 2012; McLean 2011; Smith et al. 2012).

The participative arts for people living with a dementia

13

In the past decade there has been an increasing number of arts andcultural initiatives for people who live with a dementia both in the UK andthe US (Killick 2012; Roe et al. 2014; Zeilig 2014b; Zeisel 2009). Theseinitiatives are diverse and includemusic and drama groups, creativewritingprogrammes, dance groups, puppetry, painting classes, and visits to artgalleries. Many projects use a range of arts activities to engage participantswith a dementia. In the UK there are also a number of organisations thathave emerged in the past decade that have a specific focus on using the artswith PWD. In recent years, a growing body of evidence has been compiledexploring the potential of the arts to have an impact on the health and well-being of PWD (Basting 2009; Camic et al. 2013b; Fritsch et al. 2009; Ledger& Edwards 2011). However, this field is nascent � and consolidatingevidence about the varied and often small scale, short-term projects, isproblematic.

As is cogently noted by McLean (2011) in her evidence review of theimpact of the participatory arts on older people, this is a new and emergingresearch field, with little available high quality research. This is echoedby Roe and colleagues (2014) in their discussion of the ‘‘creative arts’’ forPWD:

A strong evidence base to inform such creative arts activities is lacking . . .

Rigorous evaluation and research evidence is required to support their continuingdevelopment. (4)

Similarly, there has been scant work exploring the views of PWDconcerning their perceptions of the value of arts and culturally basedactivities.

Singing and Music Groups

The only Cochrane review of the arts for PWD that has been locatedexamines the evidence relating to music therapy (Vink et al. 2006)(updated in 2010) and is therefore not directly relevant here. However itis significant that of all possible art practices it is music that has beenexamined in a Cochrane review. This perhaps indicates that questionsregarding the therapeutic value of music for PWD have a particularinterest for investigators and practitioners alike. The specific focus of this

International Journal of Ageing and Later Life

14

review was to assess whether music therapy can diminish behavioural andcognitive problems or improve social and emotional functioning. Tenstudies were included that used a range of behavioural and psychologicaltools as outcome measures. However, the overall conclusion by Vink et al.(2006) was that the methodological quality and the reporting of theincluded studies were too poor to draw any useful conclusions. Sherrattet al. (2004) similarly highlight the limitations of research studies in thisarea.

Weaknesses in methods and questions about the reliability of data areequally pertinent when considering the role of other participative artsconsidered in this review. Many studies are beset with methodologicaldifficulties and are unable to formulate robust conclusions. Nevertheless,there have been several convincing and methodologically stringentRCTs3 investigating the role of music and singing for PWD (Cookeet al. 2010; Harrison et al. 2010; Sarkamo et al. 2014). These studies indi-cate the benefits of music and singing for PWD; albeit with varyingemphases.

Harrison et al. (2010) and Cooke et al. (2010) report on different aspectsof the same randomised controlled trial using a cross-over design � witha music intervention and a reading control group. This RCT studied theeffects of a livemusic programme on agitation, emotion, and QOL for PWD.Standardised, quantitative measures were used including the DementiaQuality of Life and Geriatric Depression Scales. Qualitative data was alsogathered but solely from the musicians involved in the programme.Although the reflective data from the musicians indicated that the inter-vention protocol was successful in terms of promoting improvements inmood, memory, general well-being, and QOL for PWD; the standardisedmeasures used with PWD did not provide evidence that the therapeutic useof live music was more effective than a group reading activity. However,results did suggest that both the music and reading activities offered

3 RCT refers to a randomised controlled trial. This is the method used in evidencebased clinical trials whereby a group of patients is randomised into anexperimental group and a control group. Using randomisation is one way inwhich any possibility of selection bias in a trial is minimised.

The participative arts for people living with a dementia

15

opportunities to improve sense of belonging, self-esteem, and depressivesymptoms in some PWD.

Sarkamo et al. (2014) similarly explored QOL for PWD. This studyadopted a single blind RCT approach to determine the long-term efficacyof a novel dyadic music intervention on PWD. A comprehensive neurop-sychological testing battery was used to evaluate cognitive domains(Sarkamo et al. 2014) and standardised scales including the Cornell�BrownScale for QOL were used to evaluate mood. This careful systematicapproach to the possible effects of music on cognitive, emotional, andsocial aspects of life for a group of PWDwith mild/moderate dementia andtheir family members demonstrates that everyday musical leisure activitiescan have an important role inmaintaining cognitive ability, enhancingmoodand QOL, and promoting the well-being of family members. The study alsoindicates the potential for using RCT designs when investigating longer-term effects of arts activities.

Definitions of music vary (Spiro 2010) and may include ‘‘active’’improvised musical activities or activities that include music but do notnecessarily have it as a main focus. Music listening amongst PWD has alsobeen investigated. This is primarily a receptive activity and represents apassive form ofmusical interaction. The effects of playing customisedmusicon the levels of agitation and depression amongst PWD was studied byJanata (2012). The study was designed as a controlled, randomised, single-site trial lasting 16 weeks. Weekly data samples were collected for theNeuropsychiatric Inventory, the Cohen�Mansfield Agitation Inventory, andthe Cornell Scale for Depression in Dementia (Janata 2012).

This study was inconclusive and it is hypothesised that this is because ofthe particular assessments used in this study (Janata 2012). The authorsconclude that more detailed examination of the interaction between music,specific agitation behaviours, dementia severity, and time of day iswarranted.

Thus there is a developing literature on the benefits of music for PWD inrelation to the behavioural symptoms of dementia and sense of well-being(Gerdner 2000; Hara 2011; Rose 2008; van der Geer et al. 2009). In addition,the specific ability of music to allay cognitive decline based on under-standings generated by the neuroscience of music has also been studied(Sarkamo et al. 2012, 2014). These latter studies indicate that music may be

International Journal of Ageing and Later Life

16

able to reduce emotional and behavioural disturbances and have positiveeffects on cognitive functioning. Yet, methodological ‘‘pitfalls’’ (Sarkamoet al. 2012) mean that conclusions about the long-term benefits andpractical applicability of music interventions remain tenuous.

The value of singing in dementia care has also been widely noted (Gotellet al. 2009). This has been reinforced by the ‘‘Singing for the Brain’’ modeland Silver Song Club Project (Skingley & Vella-Burrows 2010). The eval-uation by Bannan and Montgomery-Smith (2008) demonstrated thatsinging was an enjoyable activity for PWD and also had the potential toenhance QOL and well-being for their carers. The role of singing forimproving health has been established for other cohorts in wide rangingstudies (Cohen et al. 2006, 2007; Clift et al. 2009).

Camic et al. also observe the intense enjoyment for PWD derivedfrom singing (Camic et al. 2013b). This was a small scale but thoroughstudy (10 PWD and carers over a 10-week period) (Camic et al. 2013b) thatused quantitative and qualitative evaluative measures. The objective ofthe study was to assess whether engagement in singing groups positivelyaffected PWD. Standardised measures included assessing the PWD’scognitive abilities at baseline with the Addenbrooke Cognitive Examinationand subsequently at post-group and 10-week follow up. Their mood wasassessed with the Geriatric Depression Scale and QOL with the DementiaQuality of Life (Dem-QOL-proxy), behavioural and psychological problemswith the Neuropsychiatric Inventory and activities of daily living with theBristol Activities of Daily Living Scale (Camic et al. 2013b). In additionto these standardised measures, levels of engagement and participationwere measured using a ‘‘specially constructed’’ observational scale (Camicet al. 2013b). The qualitative data provided a different perspective than thequantitative data; whilst the former demonstrated the enthusiasm withwhich PWD participated, the standardised measures were inconclusive.Indeed, the benefit of using qualitative data with statistical analysis is alsoappreciated in the RCT study of a music intervention for PWD (Harrisonet al. 2010).

The study by Camic et al. did not support the commonly held beliefthat PWD are not interested or capable of taking on new activities (Camicet al. 2013b). Singing and music have also been used with people who arein more advanced stages of dementia and have lost all verbal skills or who

The participative arts for people living with a dementia

17

are completely bedridden (Povey 2011), however more rigorous studiesabout the role of music and singing for PWD who are in more advancedstages of the illness are required.

Art Groups: Drawing, Making and Painting

Although there may be numerous projects that use art with PWD, researchinto art-making activities for PWD is sparse (Eekelaar et al. 2012). However,despite small samples there is evidence that those with a dementia whoengage in arts activities experience improvements in social and psycholo-gical well-being. For example, Kinney and Rentz (2005) used a carefulmethod of evaluation to compare the effectiveness of a drawing andpainting programme (Memories in the Making) led by an artist facilitatorwith participation in a structured activity on the well-being of twelve adultswith a dementia at 2 day centres. Well-being was assessed using anoutcomes-based observation tool designed specifically for this study andthat focussed on seven domains of well-being. This study reported thatparticipants demonstrated increased sustained attention, engagement,and communication. However, these findings are tentative because of thesmall sample size and certain aspects of the observation tool developed(Kinney & Rentz 2005).

The work of the Magic Me group (http://www.magicme.co.uk) hasalso been successful at engaging PWD with the creation of artworks(Gilfoy & Knocker 2009) as has the small scale ‘‘Lighting Up’’ project(Sherratt 2010). However, both accounts of artists working with PWDwould benefit from both a theoretical framework and from longer-termevaluation that assesses the duration of the benefits experienced by PWDwho participate. As noted by Salisbury et al. (2011), partial explanation forthe benefits of arts interventions for PWD comes from neurologicalfindings that demonstrate how drawing therapeutically affects the brain.Future research in this area might benefit from incorporating andinvestigating these findings.

Evidence from recent studies on aesthetic perception amongst thoseliving with a dementia as noted by Graham et al. (2013), suggests thatinteractions with art can lessen the severity of AD symptoms. Theinteresting results of Graham et al.’s work (2013) indicate that:

International Journal of Ageing and Later Life

18

. . . people with AD do possess aesthetic perception much like that of healthy adults,we must explain how this is possible given that brain areas that seem to underlienormal aesthetic perception appear to be damaged in AD. (6)

The authors speculate that apparent damage may not be so severe andthat sub-cortical systems could help individuals compensate. If aestheticjudgments remain stable then the value of interventions involving artviewing are evident. This is a finding that is echoed in earlier studies(Halpern et al. 2008). Clearly a deeper understanding about the role ofvisual information may also lead to the development of novel therapiesand programmes. It may even be that other areas of aesthetic judgmentalso remain stable.

Eekelaar et al. (2012) in a project that gathered data in novel waysincluding audio recordings investigated the association between visualarts based interventions (in the context of an art gallery) and cognitivestimulation for PWD (Eekelaar et al. 2012). The study design involvedmeasuring cognitive responses to a semi-structured interview by PWD andaudio recording these, as an alternative to standardised questionnaires,which have proved problematic in research with PWD. Because of theresearch focus that was on PWD’s episodic memory and verbal fluency,questions about the gallery’s artwork were used to elicit verbal responses(Eekelaar et al. 2012). The study procedure (once consent had beenobtained) was for the PWD and carer to attend three 90-minute gallerysessions over 3 weeks. The final hour of the session was spent in an art-making session. Four weeks post intervention, participants were inter-viewed again, shown reproductions of the art they had viewed, and askedfor feedback about the group. This study, although limited in scope andscale � six PWD participated and the study took place over 7 weeks withouta control group � indicated that episodic memory and verbal fluency couldbe enhanced both by art viewing and art-making. This is a finding thatdeserves further investigation.

Ullan et al. (2013) designed a monochrome photographic procedure forpeople living with a ‘‘mild or moderate’’ form of dementia. Above all, thisproject demonstrates that the PWD who participated were able to use newtechnologies and learn new skills. Participants also enjoyed the activity.However, this study was highly selective (those with more advanced forms

The participative arts for people living with a dementia

19

of dementia were not included) and only provides information about theprocess of the workshops rather than their longer-term impact.

Dance Projects

Since the beginning of the twenty-first century there has been a markedescalation in projects and approaches using dance with PWD. In the UKthe work of Richard Coaten has been central to fostering understandingabout the intrinsic value of movement, dance, and the imagination forPWD (Coaten 2002).

Dancing with PWD has been explored in hospital settings and daycentres and positive effects have been noted. These include a decreasein challenging behaviour and the promotion of person-centred care (Coatenet al. 2013). In addition, there has been increasing recognition of the benefitsof non-verbal, body-oriented focus for PWD and the embodied nature ofthe illness, in contrast to the predominant emphasis in western culture onverbal, cognitively-based activities (Coaten & Newman-Bluestein 2013;Kontos 2005). Dance projects can increase movement range and mobilityin PWD and therefore nurture remaining capacities (Coaten et al. 2013;Smith et al. 2012). Dance is inherently interactive and playful and these areimportant qualities that dance projects can offer PWD, their carers, and thestaff of day centres/care homes (Coaten & Newman-Bluestein 2013; Smithet al. 2012). However, a recent systematic review of dance as a psychosocialintervention in care homes (Guzman-Garcıa et al. 2013) highlights thatevidence on the efficacy of dancing in care homes is limited because ofthe methodological challenges facing this research.

The ‘‘Moving Memories’’ project (Coaten et al. 2013) was relatively longterm (36 weeks) and involved a group of 10�14 PWD as well as careworkers, a researcher, and the dance artist who led the activity. The projectexplored the role that movement can play in the lives of those who livewith a dementia and also for care staff within a day centre. The reportstresses the value of having an independent researcher who was able to useethnographic processes (such as diaries) to capture the spirit of dance.Similarly, the pilot project, led by Smith et al. (2012), used qualitativemethods to gather data about the dance intervention. However, in theirreflective report, Smith et al. (2012) comment upon the limitations ofrelying upon feedback interviews with participants and the need for future

International Journal of Ageing and Later Life

20

evaluations to include film and visual mechanisms especially in danceprojects.

Theatre and Storytelling

A primary benefit of drama-based projects is the opportunity to expressemotions and thus cope with the condition of living with a dementia(Harries et al. 2013). After all, telling stories and acting these out is afundamental human experience and remains a key method for sharingexperiences.

Participatory theatre activities that include creative storytelling for PWDhave been pioneered in the US by Anne Basting in her innovative TimeSlips project (2001). Basting’s ‘‘Finding Penelope’’ project (a site specificperformance based in a Milwaukee care home; Mello & Voights 2012)has demonstrated that PWD are able to learn new skills and actively takepart, even co-direct a theatrical production. The evaluation of ‘‘FindingPenelope’’ was qualitative and drew on a wide variety of sources including:video recordings of meetings, in-depth interviews, and photographsamongst other data (Mello & Voights 2012). The goal of this project wasto transform long-term care through creative engagement . . . and alsoto change the conditions of care for persons with dementia. As eloquently notedby Zeisel (2009) the dramatic ambience itself conveys feelings andideas and thus drama provides a powerful mode of communication forPWD. This was evidenced by Basting’s project, which was also importantin generating a sense of belonging amongst participants (Zeisel 2012). Theevaluation of ‘‘Finding Penelope’’ whilst arguably limited (it was written bya member of the project team) found that the theatrical project had made apositive difference in the quality of residents’ and staff lives.

Basting’s work is important in encouraging creative work that doesnot rely on memory. The Storybox project (a UK theatre based project)similarly emphasises creating rather than reminiscing, this is associatedwith a failure-free atmosphere (Harries et al. 2013). In addition, improvisa-tion is often central to participatory theatre. Improvisation allows PWDto dare, to play, and to create, and is a process that many find liberating(Basting 2001). Improvisation also facilitates inclusion by fostering col-laboration, fun, and experimentation (Harries et al. 2013). The model ofinteractive theatre that has been used with PWD by the group ‘‘Ladder

The participative arts for people living with a dementia

21

to the Moon’’ (Zeisel 2009) similarly encourages co-creation and experi-mentation as a means of involving as many PWD as possible.

The dramatic staging and performing of the stories of PWD is animportant means of combatting prejudice and stigma about dementia(Zeisel 2009). Even within care homes, theatrical performances have haddemonstrably positive effects on the attitudes of staff � as outlined inthe evaluative report of the ‘‘Ladder to the Moon’’ residency (Parsons 2009).However, whether altered attitudes are evidenced in changed caringpractices is less apparent (Parsons 2009).

Poetry and Writing

Poetry appeals to similar parts of the brain as song (Zeisel 2009). The needfor rhythm and rhyme is innately human and it is posited that this is oneof the reasons that working with PWD to create poetry is so appropriate.In the UK John Killick has pioneered ways of working with PWD toco-write poetry. This work and the poems produced (Killick 1997, 2007,2008) have contributed to insights into the worlds of some individualsliving with a dementia.

In addition, Killick’s work has persistently emphasised the existence ofselfhood, the ability to communicate in language, and to exercise creativechoice even at relatively late stages of a dementia. The importance of thecollective creation in creating poetry with PWD is also highlighted in otherstudies (Aadlandsvik 2008). Participants might not be able to write anylonger but can direct the poet (who acts as an amanuensis for the PWD) andthis allows PWD some degree of control and autonomy. The one-to-oneinteractions of a poet with a PWD and the personal nature of the activitymay be a major factor contributing to the success of these interventions(Gregory 2011).

Poetry is also used with PWD as something to recite together or to readwith PWD and has been found to be a means of releasing an individual’spersonality (Glazner 2006). Creating poetry as a means of encouragingreminiscence was the focus of the ‘‘Try to Remember’’ project (2011);however the views and benefits for PWD were not the explicit focus ofthis study. A study of a literature-based intervention for PWD (Billingtonet al. 2013) that addressed the impact and effect of shared reading onPWD found that there was a significant reduction in dementia symptom

International Journal of Ageing and Later Life

22

severity but similarly failed to investigate the views or opinions of PWDin any detail.

Despite the anecdotal evidence thatmany projects use poetry and creativewriting with PWD, studies evaluating the efficacy of these interventions(especially from the point of view of the PWD) are scant and workexamining the applications of poetry using rigorous, robust methodologiesis rather sparse.

The Role of Museums and Art Galleries

Museums are public places that are non-stigmatising and that havewebsites that extend beyond the boundaries of the physical place (Camic& Chatterjee 2013). However, despite the increase in understandingabout the possible cognitive and psychological benefits of arts and healthinterventions in museums, research is still at an early stage (Camic &Chatterjee 2013).

Art galleries as a ’’normal,’’ intellectually stimulating location for socialinteraction have great potential for engaging PWD especially given thepossibilities that aesthetic perception remains relatively stable for PWD(Graham et al. 2013). Art galleries can use their resources to devise projectsthat engage PWD quite easily (Camic & Chatterjee 2013; Camic 2013a;MacPherson et al. 2009; Rosenberg et al. 2009; Zeisel 2009). Participatoryprojects in art galleries can use a variety of methods for engagement,including structured discussions of actual artworks followed by opportu-nities for art-making (Camic et al. 2013a; Roe et al. 2014). Indeed thecontroversial area of new learning for PWD has been confronted by Camicboth in the context of a singing group (2013), and within a gallery setting(2013a). In both instances, the research team found that PWD were ableto undertake new learning.

Traditional art gallery settings have been the focus for most studiesexploring the influence of the location of participatory arts projects forPWD (Camic & Chatterjee 2013; Camic et al. 2013a; Eekelaar et al. 2012;MacPherson et al. 2009; Rosenberg et al. 2009). This area could be expandedby exploring the effects of similar projects at different, less conventionaltypes of galleries and museums (as noted by Camic et al. 2013a).

Memories that are visually encoded are vivid and can be easilystimulated; this explains the powerful nature of visual stimulation in art

The participative arts for people living with a dementia

23

galleries, as noted by Rosenberg et al. (2009). Similarly, Zeisel (2009) makesnumerous observations about the possibilities that PWD have for aestheticappreciation of art that are based on his experience of museum tours withhis ‘‘Artists for Alzheimer’s’’ programme.

Issues of Evaluation

The thorny issue of adequately evaluating complex interventions suchas participative arts projects: that involve interrelated variables, confound-ing factors, and a range of possible outcomes, was a recurring theme in theliterature reviewed. Some of the main concerns relate to the use of inap-propriate outcomemeasures; for example, Camic et al. (2013b) highlight theinadequacy of standardised QOL measures for people with a dementia.In addition, overtly clinical approaches to evaluating the participative arts �for example, investigating cognitive effects or the impact of ‘‘doses’’ ofmusic� has also been queried (Harries et al. 2013; de Medeiros & Basting 2014).

However, it is important to note that it is not solely the participative artsfor PWD that are difficult to evaluate. In their general guidance on theevaluation of complex interventions, the Medical Research Council notesthat whilst there are some aspects of good practice that are evident:

. . . on many important issues there is no consensus yet on what is best practice.(Craig et al. 2008: 6)

In large part, this is because of the methodological and practicalconstraints that affect the evaluation of complex interventions.

Discussion

According to the literature reviewed, the participative arts are able tocontribute positively to the lives of those living with a dementia in manifoldways. These include: aiding communication; encouraging residual creativeabilities; promoting new learning; enhancing cognitive function; increasingconfidence, self-esteem, and social participation; and generating a sense offreedom � among other documented benefits. In addition, the arts areeffective at alleviating boundaries between service providers and peoplewith dementia and in providing new insights for the dementia workforceand family members. The arts have a unique application for uncovering

International Journal of Ageing and Later Life

24

and communicating the interior worlds of those living with a dementia(Gjengedal et al. 2014; Ryan et al. 2009). The spate of recent theatreproductions, memoirs, and films exploring various aspects of living witha dementia indicate that there is a receptive and wide audience for artisticcontemplations of this condition.

Yet the complex role of the participative arts for PWD is a field that is inits infancy. Moreover, because of methodological challenges, and a dearthof theoretically informed work, most conclusions are tentative rather thanconfident, particularly concerning the long-term impact of arts projects.However, recent studies using RCT designs to investigate singing andmusic for PWD (Harrison et al. 2010; Sarkamo et al. 2014) reflect thegrowing interest in systematic research in this area. As noted elsewhere:

The basic research has begun, and the field is now ready for a deeper exploration . . . .(Spiro 2010: 897)

In concurrence, this review indicates that the evidence base can certainlybe strengthened. In particular, studies that take place over longer timeperiods with more diverse groups of PWD and that use a variety ofevaluative methods (several studies have demonstrated the efficacy ofcombining qualitative with quantitative measures) are needed.

As Hara points out, in particular relation to research on the effects ofmusic on PWD Hara (2011), the neuroscientific approach tends to examinemusic as an isolated phenomenon (separate from the social context) andto examine it solely in terms of its ability to effect change. Thus the effectof music is measured in a specific and predefined way, much like apharmaceutical drug. This aptly highlights a key difficulty in evaluatingthe role of the participative arts for PWD � the number of external,confounding factors, and the importance of appreciating the whole context.Studies that explore the underlying cognitive, neurological, and emotionalmechanisms that may be affected are required. In addition, studies thatdraw on appropriate theoretical models and that consciously integratethe views of participants living with a dementia should be conducted inorder to make reliable conclusions that are generally applicable and havepractical relevance for PWD. Furthermore, economic analysis should beincluded in studies of the participatory arts for PWD so that commission-ing agencies can make decisions regarding the relative expense of these

The participative arts for people living with a dementia

25

groups (Camic et al. 2013b) in comparison with other therapeutic orpharmacological interventions.

Despite the need for further stringent evaluative research, the workthat has already been conducted indicates that the participative arts willcontinue to develop and respond to the needs of PWD in uniquely valuableways. In particular, recent work in the UK (Zeilig et al. 2014), indicatesthat feelings of peace may be generated for PWD by music making, andthat arts projects can produce internal connections and also friendships.In addition, arts projects can create a space that is outside the demandsof daily life and the ability for PWD to engage reciprocally. Whilst it isdifficult to establish whether these effects are intrinsically associated withthe arts activity as opposed to any other form of social participation;the inherent emphasis of most arts projects is on group creation andplayfulness. The focus on play and creation privileges the present momentand is particularly valuable for PWD.

After all, the emphasis of the arts is on experience, feeling, imagination,and meanings that lie to the side of our vision, meanings that may bemasked and cannot easily be measured. The emphasis on emotions thatis integral to the arts is of particular relevance for PWD and their carers.Moreover, if health is more than the absence of disease and is primarilyabout adaptation, understanding, and acceptance (Davies et al. 2014) thenthe arts may indeed be more powerful for those living with a dementia thananything medicine has to offer.

AcknowledgementsThis literature review forms essential background for Mark Makinga study exploring the role and value of the participative arts for PWD.This was funded by the Arts and Humanities Research Council andsupported by the University of the Arts, London. The research team isindebted to the artists, participants, and staff of the participative artsprojects that they worked with.

Corresponding AuthorHannah Zeilig, London College of Fashion, University of the Arts, 20 JohnPrince’s Street, London W1G 0BJ, UK. Email: h.zeilig@fashion.arts.ac.uk

International Journal of Ageing and Later Life

26

References

Aadlandsvik, R. (2008). The second sight: Learning about and withdementia by means of poetry. Dementia 7(3): 321�339.

Bannan, N. & Montgomery-Smith, C. (2008). Singing for the brain:Reflections on the human capacity for music arising from a pilot studyof group singing with Alzheimer’s patients. The Journal of the RoyalSociety for the Promotion of Health 128(2): 73�78.

Basting, A. (2001). ‘‘God Is a Talking Horse’’: Dementia and the per-formance of self. The Drama Review 45(3): 78�96.

Basting, A. D. (2009). Forget Memory: Creating Better Lives for People withDementia. Baltimore: John Hopkins University Press.

Billington, J., Carroll, J., Davis, P., Healey, C. & Kinderman, P. (2013).A literature-based intervention for older people living with dementia.Perspectives in Public Health 133(3): 165�173.

Burnham, A., Lammy, D., Cayton, H. & Hewitt, P. (2007). A Prospectus forArts and Health. London: Department of Health.

Buttrick, J., Parkinson, A., Wallis, A., Trentham, S. & Riseborough, M.(2013). What do we know about the role of arts in the delivery of social care?London: Skills For Care.

Camic, P. M. & Chatterjee, H. J. (2013). Museums and art galleries aspartners for public health interventions. Perspectives in Public Health133(1): 66�71.

Camic, P. M., Tischler, V. & Pearman, C. H. (2013a). Viewing and makingart together: A multi-session art-gallery-based intervention for peoplewith dementia and their carers. Aging & Mental Health 18(2): 161�168.

Camic, P. M., Williams, C. M. & Meeten, F. (2013b). Does a ‘SingingTogether Group’ improve the quality of life of people with a dementiaand their carers? A pilot evaluation study. Dementia 12(2): 157�176.

Castora-Binkley, M., Noelker, L., Prohaska, T. & Satariano, W. (2010).Impact of arts participation on health outcomes for older adults. Journalof Aging, Humanities, and the Arts 4(1): 352�367.

Cayton, H. (2007). Report of the Review of Arts and Health Working Group.London: Department of Health.

Clift, S. (2012). Creative arts as a public health resource: Moving frompractice-based research to evidence-based practice. Perspectives in PublicHealth 132(3): 120�127.

The participative arts for people living with a dementia

27

Clift, S., Camic, P. M., Chapman, B., Clayton, G., Daykin, N., Eades, G.,Parkinson, C., Secker, J., Stickley, T. & White, M. (2009). The state ofarts and health in England. Arts & Health 1(1): 6�35.

Coaten, R. (2002). Movement Matters: Revealing the hidden humanitywithin dementia through movement, dance and the imagination.Dementia: The International Journal of Social Research and Practice 1(3):386�391.

Coaten, R., Heeley, T. & Spitzer, N. (2013). Dancemind ‘s’ movingmemories’ evaluation and analysis; a UK based dance and healthproject for people living with dementia and their care-staff. UNESCOObservatory Multi-Disciplinary Journal in the Arts 3(3): 1�17.

Coaten, R. & Newman-Bluestein, D. (2013). Embodiment and dementia �Dance movement psychotherapists respond. Dementia 12(6): 677�681.

Cohen, G. D. (2009). New theories and research findings on the positiveinfluence of music and art on health with ageing. Arts & Health: AnInternational Journal for Research, Policy and Practice 1(11): 48�62.

Cohen, G. D., Perlstein, S., Chapline, J., Kelly, J., Firth, K. M. & Simmens, S.(2006). The impact of professionally conducted cultural programs onthe physical health, mental health, and social functioning of olderadults. The Gerontologist 46(6): 726�734.

Cohen, G. D., Perlstein, S., Chapline, J., Kelly, J., Firth, K. M. & Simmens, S.(2007). The impact of professionally conducted cultural programs onthe physical health, mental health, and social functioning of olderAdults � 2-Year results. Journal of Aging, Humanities, and the Arts 1(1�2):5�22.

Cooke, M., Moyle, W., Harrison, S. & Murfield, J. (2010). A randomizedcontrolled trial exploring the effect of music on quality of life anddepression in older people with dementia. Journal of Health Psychology15(5): 765�776.

Craig, C. & Killick, J. (2011). Why creativity and dementia go together.Journal of Dementia Care 19(6): 20�22.

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. & Petticrew, M.(2008). Developing and Evaluating Complex Interventions: New Guidance.London: Medical Research Council.

Davies, C. R., Knuiman, M. & Wright, P. (2014). The art of being healthy: Aqualitative study to develop a thematic framework for understanding

International Journal of Ageing and Later Life

28

the relationship between health and arts. British Medical Journal Open 4:1�10. doi: 10.1136/bmjopen-2014-004790.

de Medeiros, K. & Basting, A. (2014). ‘‘Shall I compare thee to a doseof Donepezil?’’: Cultural arts interventions in dementia care research.The Gerontologist 54(3): 344�353.

Eekelaar, C., Camic, P. M. & Springham, N. (2012). Art galleries, episodicmemory and verbal fluency in dementia: An exploratory study.Psychology of Aesthetics, Creativity, and the Arts 6(3): 262�272.

Fritsch, T., Kwak, J., Grant, S., Lang, J., Montgomery, R. R. & Basting, A. D.(2009). Impact of TimeSlips, a creative expression intervention pro-gram, on nursing home residents with dementia and their caregivers.The Gerontologist 49(1): 117�127.

Gerdner, L. A. (2000). Music, art, and recreational therapies in the treat-ment of behavioral and psychological symptoms of dementia. Interna-tional Psychogeriatrics 12(Suppl S1): 359�366.

Gilfoy, K. & Knocker, S. (2009). Magic across the generations. Journal ofDementia Care 17(3): 22�25.

Gjengedal, E., Lykkeslet, E., Sørbø, J. I. & Sæther, W. H. (2014). Brightnessin dark places’: Theatre as an arena for communicating life withdementia. Dementia 13(5): 598�612.

Glazner, G. (2006). The rhyme and reason of poetry therapy. CareAdvantage (Spring): 24�27.

Gotell, E., Brown, S. & Ekman, S. (2009). The influence of caregiver singingand background music on vocally expressed emotions and moods indementia care: A qualitative analysis. International Journal of NursingStudies 46(4): 422�430.

Graham, D. J., Stockinger, S. & Leder, H. (2013). An island of stability:Art images and natural scenes � but not natural faces � showconsistent esthetic response in Alzheimer’s-related dementia. Frontiersin Psychology 4(107): 1�8.

Gregory, H. (2011). Using poetry to improve the quality of life and care forpeople with dementia: A qualitative analysis of the Try to Rememberprogramme. Arts & Health 3(2): 160�172.

Gross, S. M., Danilova, D., Vandehey, M. A. & Diekhoff, G. M. (2013).Creativity and dementia: Does artistic activity affect well-being beyondthe art class? Dementia doi: 10.1177/1471301213488899.

The participative arts for people living with a dementia

29

Guzman-Garcıa, A., Hughes, J. C., James, I. A. & Rochester, L. (2013).Dancing as a psychosocial intervention in care homes: A systematicreview of the literature. International Journal of Geriatric Psychiatry 28(9):914�924.

Halpern, A. R., Ly, J., Elkin-Frankston, S. & O’Connor, M. G. (2008). ‘knowwhat I like’: Stability of aesthetic preference in Alzheimer’s patients.Brain and Cognition 66: 65�72.

Hanna, G. & Perlstein, S. (2008). Creativity Matters: Arts and Agingin America. Washington, DC: National Center for Creative Aging,Monograph.

Hara, M. (2011). Music in dementia care: Increased understanding throughmixed research methods. Music & Arts in Action 3(2): 34�58.

Harries, B., Keady, J. & Swarbrick, C. (2013). The Storybox Project:Examining the Role of a Theatre and Arts-Based Intervention for Peoplewith Dementia. Manchester: University of Manchester.

Harrison, S., Cooke, M., Moyle, W., Shum, D. & Murfield, J. (2010).Delivering a music intervention in a randomized controlled trialinvolving older people with dementia: Musician experiences andreflections. Music and Medicine 2(4): 214�218.

Janata, P. (2012). Effects of widespread and frequent personalized musicprogramming on agitation and depression in assisted living facility re-sidents with Alzheimer-Type dementia. Music and Medicine 4(1): 8�15.

Kaldy, J. (2013). Alternative therapies for a new era of health care.The Consultant Pharmacist 28(2): 84�90.

Killick, J. (1997). You Are Words. London: Hawker.Killick, J. (2007). Dementia and ‘Me-ness’. The poetry of Ian McQueen.

Alzheimer’s Care Quarterly 8(1): 8�11.Killick, J. (2008). It moves you, it hits you inside. Reading poems at

Redholme. Journal of Dementia Care 16(6): 28�29.Killick, J. (2012). Working as an Artist with People with Dementia, Briefing

Report for National Association of Writers in Education (NAWE).Available on http://www.nawe.co.uk/writing-in-education/writing-and-community/artworks/nawe-lab.html

Killick, J. (2013). Dementia Positive. Edinburgh: Luath Press.Kinney, J. M. & Rentz, C. A. (2005). Observed well-being among

individuals with dementia: Memories in the Making#, an art program,

International Journal of Ageing and Later Life

30

versus other structured activity. American Journal of Alzheimer’s Diseaseand Other Dementias 20(4): 220�227.

Kitwood, T. (1997). Dementia Reconsidered, the Person Comes First. Maiden-head: Open University Press.

Knopman, D., DeKosky, S. T., Cummings, J., Chui, H., Corey-Bloom, J. &Stevens, J. (2001). Practice parameter: Diagnosis of dementia: Anevidence-based review. Report of the quality standards committee ofthe American Academy of Neurology. Neurology 56(9): 1143�1153.

Kontos, P. C. (2005). Embodied selfhood in Alzheimer’s disease: Rethink-ing person-centred care. Dementia 4(4): 553�570.

Ledger, A. & Edwards, J. (2011). Arts-based research practices in musictherapy research: Existing and potential developments. The Arts inPsychotherapy 38(5): 312�317.

MacPherson, S., Bird, M., Anderson, K., Davis, T. & Blair, A. (2009). Anart gallery access programme for people with dementia: You do it forthe moment. Aging & Mental Health 13(5): 744�752.

McFadden, S. H., Frank, V. & Dysert, A. (2008). Creativity in the ‘‘Now’’ ofadvanced dementia: Glimpses of the lifeworld through storytellingand painting. Journal of Aging, Humanities, and the Arts 2(2): 135�149.

McLean, J. (2011). An Evidence Review of the Impact of Participatory Arts onOlder People. London: Mental Health Foundation.

Mello, R. & Voights, J. (2012). The Penelope Project: Using the Power of Myth toTransform Long Term Care. Available on http://www.thepenelopeproject.com/links/materials/penelope-program-evaluation (Accessed: March18, 2014).

Mirza, M. (ed.) (2006). Culture Vultures: Is UK arts policy damaging the arts?London: Policy Exchange.

Moriarty, J. (2003). Innovative practice. Dementia 2(1): 125�135.Moss, H. & O’Neill, D. (2014). The art of medicine: Aesthetic deprivation

in clinical settings. The Lancet 383(9922): 1032�1033.Mowlah, A., Niblett, V., Blackburn, J. & Harris, M. (2014). The Value of

Arts and Culture to People and Society. Manchester: Arts CouncilEngland.

Owen, J. W. (1999). Arts, health and wellbeing: A third way for health?World Hospitals and Health Service: The Official Journal of the InternationalHospital Federation 35(2): 3�6.

The participative arts for people living with a dementia

31

Parkinson, A., Buttrick, J., Wallis, A., Trentham, S. & Riseborough, M.(2013). What Do we Know about the Role of Arts in the Delivery of SocialCare? London: Skills for Care.

Parsons, M. (2009). Over the Moon: Effectiveness of Using Interactive Dramain a Dementia Care Setting, Evaluation Report. London: London Centrefor Dementia Care.

Povey, S. (2011). Music lessons: Listening with your whole being. Journalof Dementia Care 19(4): 32�33.

Ramsey, P. (2013). Arts and older people strategy 2010�2013, Arts Councilof Northern Ireland. Cultural Trends 22(3�4): 270�277.

Renshaw. (2013). Being in Tune, A Provocation Paper: Seeking Ways ofAddressing Isolation and Dislocation Through Engaging in the Arts.London: Guildhall School of Music and Drama.

Roe, B., McCormick, S., Lucas, T., Gallagher, W., Winn, A. & Elkin, S.(2014). Coffee, cake & culture: Evaluation of an art for health prog-ramme for older people in the community. Dementia. doi: 10.1177/1471301214528927. Available on http://dem.sagepub.com/content/early/2014/03/25/1471301214528927 (Accessed: April 14, 2014).

Rose, L. (2008). Music for Life: A model for reflective practice. Journal ofDementia Care 16(3): 20�23.

Rosenberg, F., Parsa, A., Humble, L. & McGee, C. (2009). Meet Me: MakingArt Accessible to People with Dementia. New York: Museum of ModernArt.

Ryan, E. B., Bannister, K. A. & Anas, A. P. (2009). The dementia narrative:Writing to reclaim social identity. Journal of Aging Studies 23(3): 145�157.

Sabat, S. R. (2001). The Experience of Alzheimer’s Disease. Life Through aTangled Veil. Oxford: Blackwell.

Salisbury, K., Algar, K. & Windle, G. (2011). Arts programmes and qualityof life for people with dementia: A review. Journal of Dementia Care19(3): 33.

Sarkamo, T., Laitinen, S., Tervaniemi, M., Numminen, A., Kurki, M. &Rantanen, P. (2012). Music, emotion, and dementia: Insight fromneuroscientific and clinical research. Music and Medicine 4(3): 153�162.

Sarkamo, T., Tervaniemi, M., Laitinen, S., Numminen, A., Kurki, M.,Johnson, J. K. & Rantanen, P. (2014). Cognitive, emotional, and social

International Journal of Ageing and Later Life

32

benefits of regular musical activities in early dementia: Randomizedcontrolled study. The Gerontologist 54(4): 634�650.

Sherratt, C. (2010). Lighting up: Lessons learned in establishing an artsproject. Journal of Dementia Care 18(6): 22�23.

Sherratt, K., Thornton, A. & Hatton, C. (2004). Music Interventions forPeople with Dementia: A Review of the Literature. Aging & MentalHealth 8(1): 3�12.

Skingley, A. & Vella-Burrows, T. (2010). Therapeutic effects of music andsinging for older people. Nursing Standard 24(19): 35�41.

Smith, N., Waller, D., Colvin, A., Naylor, M. & Hayes, J. (2012). Dance andDementia Project: Findings from the Pilot Study. Brighton: Unviersity ofBrighton.

Spiro, N. (2010). Music and dementia: Observing effects and searching forunderlying theories. Aging & Mental Health 14(8): 891�899.

Staricoff, R. L. (2006). Arts in health: The value of evaluation. Journal of theRoyal Society for the Promotion of Health 126(3): 116�120.

Stephan, B. & Brayne, C. (2010). Prevalence and projections of dementia. InM. Downs & B. Bowers (eds.), Excellence in Dementia Care: Research intoPractice (pp. 9�35). Berkshire: Open University Press.

Ullan, A. M., Belver, M. H., Badıa, M., Moreno, C., Garrido, E., Gomez-Isla,J., Gonzalez-Ingelmo, E., Delgado, J., Serrano, I., Herrero, C., Manzanera,P. & Tejedor, L. (2013). Contributions of an artistic educational programfor older people with early dementia: An exploratory qualitative study.Dementia 12(4): 425�446.

van der Geer, E. R., Vink, A. C., Schols, J. M. G. A. & Slaets, J. P. J. (2009).Music in the nursing home: Hitting the right note! The provision ofmusic to dementia patients with verbal and vocal agitation in Dutchnursing homes. International Psychogeriatrics 21(01): 86�93.

Vink, A. C., Birks, J., Bruinsma, M. S. & Scholten, R. J. P. M. (2006). MusicTherapy for People with dementia. Cochrane Database of SystematicReviews (3): CD003477. doi: 10.1002/14651858.CD003477.pub2.

Zeilig, H. (2014a). Dementia as a cultural metaphor. The Gerontologist 54(2):258�267.

Zeilig, H. (2014b). Gaps and spaces: Representations of dementia incontemporary British poetry. Dementia 13(2): 160�175.

The participative arts for people living with a dementia

33

Zeilig, H., Killick, J. & Fox, C. (2014). Mark Making: A Critical Review of theValue of Arts and Culture for People Living with a Dementia. London:University of the Arts and Humanities Research Council.

Zeisel, J. (2009). I’m Still Here: A Breakthrough Approach to UnderstandingSomeone Living with Alzheimer’s. New York: Penguin Group (USA).

International Journal of Ageing and Later Life

34